1. THE REFORM AGENDA 2017 – 2027 Public Services Working
Together to Reduce Demand
Tuesday 21st November the Education Centre, Basildon & Thurrock University Hospitals
Dr. Patricia Oakley, Director
Practices Made Perfect Ltd . Workforce Research Fellow King’s College, London University .

2. PUBLIC SERVICES IN THE 21st CENTURY
More public services for the same/less money.
More technology, science and informatics to increase efficiency and efficacy.
More multi-agency working to develop shared understanding of problems and approaches to commissioning services and deploying staff.
Better educated and trained joint workforces to solve complex problems.
Better reconciliation of delivery now while developing for the future.

3. The Next 30 years
Care of the Elderly – physically well and mobile, socially engaged and psychologically content.
Chronic Disease Management including Mental Health and Carer Support.
Specialist Surgical and Therapeutic Interventions.
New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics.
Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

4. New service design principles
Home Service
Single-people enabled Homes and Campuses
Hospital @ Home Service
New service design principles
“High Street” Screening and Diagnostic Centres
(high science and technology)
Community Activity Centres and The Gym
Re-enablement, Rehabilitation and Resettlement Centres
GP Well-being Practices and Managed Care Centres
(Cancer, Stroke/Cardio, Mental Health)
© Practices Made Perfect
Trauma Centres
Urgent Care Centres
Planned Care Centres
Nursing and Care Homes
Step-down/Convalescent Homes

5. SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS
The Goals of Integrated Care Programmes
Build a fabric of dense social networks within which good quality health and social care interventions are delivered in a timely and sensitive way.

6. What is the Role of the State?
SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS
Reducing Isolation
Support for family, friends and community self-help groups.
Support for collectivising events and activities.
Support for patient-focused charities and enabling groups.
What is the Role of the State?

7. The Place In The Middle High Street The Home Tests? The Gym Tests?
Maternity & Neonatology
Care Services
(including children’s trauma service)
(includes current A&E “minors” service)
Regional Trauma Services
Urgent Care Services
Cancer, Cardiac, Stroke Care Services
Mental Health Care Services
(inpatients)
Convalescent, Observation and Place of Safety Beds and Services.
Minor Injuries and “Off-legs” Front Door Services.
Planned Care and Rehabilitation Services.
Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes.
End of Life Services.
Local Care Services
(including mental health and planned care services)
Genetics Services
Social & Probation and Police Services
(including children’s urgent care service)
Paramedic/Blue Light Service Services
High Street
Social Care Services
Hospice and Hospital at Home Services
Community Pharmacy and Medicines Services
GP Surgeries and Out of Hours Services
Community Nursing and Midwifery and Therapy Services
The Home Tests?
The Gym Tests?
Point of Testing Services?
Local Diagnostic Services?
Local Imaging Services?
Local Genomics Services?
Regional Diagnostic Services?
Regional Imaging Services?
Regional Genomics Centres and Predictive Analytics Services?

8. THE NELSON CENTRE
A modern NHS facility providing integrated care for the local community

9. THE NELSON CENTRE – CRUCIBLE OF CHANGE
a happening place in the centre of a community;
a shared place of many players and professionals;
a vehicle to develop new ways of working;
a locus of major new investments;
a crucible of change in workforce deployment.

10. TRANSFORMATION AGENDA INTEGRATION
STPs and Federated (possibly merged) Ways of Working.
£1.5bn investment in new assets.
Hull’s Integrated Public Services Model.
Children’s and Young People’s Services.
Integration with the Local Authority, FRS, and Community Policing.

11. MULTI-AGENCY CHILDREN’S SERVICES
EDUCATION AUTHORITY
Sure start and Mum’s support.
Skills for life and education.
Exclusions and referral units.
PARTNERSHIP AGENDA
Integrated Legal Trust?
Group Commissioner of Children’s Services?
Information and Informatics Network?
Talking Shop?
Discrete focus e.g. CAMHS?
POLICE AUTHORITY
Child Protection.
Custody and CJD.
Links with HMPS and NPS for children being resettled.
HEALTH AUTHORITY
Primary services.
Secondary services.
Tertiary services.
SOCIAL SERVICES/LOCAL AUTHORITY
Child Protection and Adoption.
Families and risk and in care.
Young Adults support.

12. MANCHESTER COMMISSIONING AUTHORITY (Bolton, Manchester, Rochdale, Stockport, Trafford, Bury, Oldham, Salford, Tameside, Wigan)
10 Local Authorities, 12 CCGs, 15 NHS Providers, Police and Crime and Fire and Rescue Commissioners, Primary Care, and the 3rd Sector.
Greater Manchester Health and Social Care Strategic Partnership Board’s Priorities:
Chronic care and long-term conditions
Severe and long-term mental health
Community and mental health care
Learning Disabilities Investment Strategy
Dementia and “Dementia United”
Greater Manchester Police’s Priorities:
Anti-social behaviour and community cohesion
Victim support
Protecting vulnerable people
Transformation Fund of £450m/£6bn.
Cornwall, Essex and Greater London Authority similar shifts and developments.

13. HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes
Cardiac Review – fags, booze and do’nuts.
Statins and Fluorine – heart attacks and fillings.
Loneliness and Isolation – diabetes (& others?).
Fire Alarms and Education – fires and deaths.
Deprivation and Problem Families – exclusion and career criminals.

14. HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes
Atlas of Variation – big differences in:
Diabetes
Children and young people
Kidney disease
Respiratory disease
Liver disease.
Schizophrenia and psychoses – 20 year gap in death rates.
Rehabilitation and resettlement of offenders – 60% recidivism rates.

15. DEVELOPING PARTNERSHIPS BUILDING THE FRAMEWORK
(Based on CLINKS)
Level 1: Baseline map of who is available and establish Service Level Agreements Sub-contracting arrangements.
Level 2: Own strategy and own work programmes but agree to exchange information and establish a concordat to share information and possibly thinking.
Level 3: Own strategy, some joint training but separate delivery and accountability arrangements.
Level 4: Joint strategy, joint training and joint delivery within a joint accountability framework.
(Level 5: Legal and practice integration.)

16. Practices Made Perfect Ltd.
Thank You
Dr. Patricia Oakley
Practices Made Perfect Ltd.